Patient Primer: What's in a name?

Patient Primer: What's in a name?

Cannabis by any other name would heal as well

Cannabis by any other name would heal as well

The notion that a name of an object does not reflect what it really is as put forth by William Shakespeare’s play Romeo and Juliet applies not only to the tale of the star-crossed lovers, but also to cannabis strains. Much like the Montague name, the specific names of cannabis strains doesn’t matter – it is the actual composition of the medicine that is of the utmost importance.
The variety of names is a result of hybridization which has created an infinite number of strain possibilities. Cannabis strains are either pure or a hybrid mixture of Cannabis sativa and Cannabis indica. Hybrid varieties are grown in order to intensify specific characteristics of the plant. The variety name, often coined by the grower, reflects certain traits of the plant such as smell, color, taste, or origin of the specific variety.
Hybrid varieties can also be used as a marketing tool to differentiate themselves from one another. Hybrid varieties tailored for medicinal purposes have been traditionally different than the varieties customized for the recreational market. The latter varieties have been genetically bred to have a higher concentration of tetrahydrocannabinol (THC) while the former varieties have a higher composition of other cannabinoids such as cannabidiol (CBD).
The genotype, or genetic makeup, and phenotype, the observable traits, work hand in hand to produce a wide spectrum of strains -- from pure sativa to pure indica and all imaginable combinations in between. The interaction of the genotype and the environment will produce a distinctive phenotype, such as the smell (terpenes), shape, color, and concentration of cannabinoids, of which there are over 80.

The Breeding Ground

The breeding of Cannabis sativa (Latin for cultivated) and Cannabis indica (originally collected in India) produces a variety of different strains. Sativa is the slower growing, taller species with long branches and large narrow bladed leaves. Indica, on the other hand, is the shorter and bushier species, with wider leaflets.
Traditionally sativa is known for its cerebral effects while indica for its sedative properties. Breeding requires pollination of the female cannabis plant with the male pollen. In order to create specific varieties, selective breeding methods are utilized.
Once bred, the names and nomenclatures for the varieties traditionally have been given by the grower. Obviously, marketing has influenced this process with popular strains being produced. Distinctive and catchy strain names have been used in order to distinguish different varieties and to differentiate strains from one another.
But as a consumer, what do these varieties mean? Unfortunately there may be a significant difference in the composition of strains that bear the same name. This becomes very frustrating for the patient, as there is uncertainty in the medicine they are purchasing.
This is also a big dilemma for recommending physicians. Most physicians are not familiar with cannabis products but even if they were knowledgeable about the various strains, the composition of the strains can be different. With the strict laboratory testing of medical cannabis in Nevada, strains will now offer consistency and breeding particulars because medicines will have the ratios and components printed on the label.

THC, CBD, and Terpenes

Historically, especially during the clandestine years, growers were keen on producing strains with the highest concentration of THC, the psychoactive component, which was desired by consumers.
With the legalization of cannabis for medical purposes and the medicinal properties of other cannabinoids (CBD) coming to light, more growers are beginning to focus some of their crops to breed high CBD:THC varieties.
Furthermore, the specific terpene composition has opened the door for new strain varieties. Terpenes are the aromatic oil compounds secreted by the trichomes, which also produce cannabinoids, on the cannabis plant giving each plant its unique aroma. Laboratories have added terpene profiles to their reporting algorithm. Thus, a better scientific makeup of each strain is delineated. There appears to be a synergistic relationship (entourage effect) between cannabinoids and terpenes in the body.
Both cannabinoids and terpenes bind to cannabinoid receptors in the body and affect neurotransmitters’ production, cannabinoid transportation into the brain, and chemical reaction at the cannabinoid receptors. Now, medical research has to catch up and decipher what role terpenes play in shaping this plant into medicine.

A Rose by Any Other Name...

As a physician, it’s not so much the name of a medical cannabis variety that is important but rather its actual composition. Research of specific varieties will be necessary to fully understand the efficacy of cannabis for specific aliments being treated. Future research will be a key factor in understanding, optimizing and expanding this fledgling field.
Dr. Pouya Mohajer is a Diplomate of the American Board of Anesthesiology with a subspecialty in pain medicine, and founder of Nevada Cannabis Medical Association.